My Opinion: What I learned as a Medical Bill Collector

This is going to probably be an unpopular opinion, but I’m going to share it anyways. I have worked as a bill collector (third party contracted) to attempt to collect those who owe medical debt, and after what I’ve seen I don’t think getting a single-payer system is going to work as nicely as everyone dreams it should.

Don’t get me wrong, I think it’d be great if we could all have affordable healthcare and it was a single payer system and life was good. However, a utopia like that just isn’t likely to exist, and there are problems inherent in any system. It bothers me when I hear people saying how much more affordable single payer would be, when I see how utterly irresponsible most medical debt is.

Consider This: I’ve spoken with people who live in Canada. Thanks to the internet, this is possible. I am aware that they have long wait times to see a doctor, and often they don’t get a lot of choice in who they see. This is thanks to their single payer healthcare. So many of them who can afford it, come to the United States so they have a choice and can get seen in a more timely manner. These are things our Veterans complain of too, and remember, Veterans are on a single payer system already run by our government.

So as a bill collector that goes after medical debt, I’ve see what typically accumulates, and I’m here to tell you that 75% of medical debt [sent to collections] is unpaid copays. The majority of people that the office I work in contact are those who are hundreds of dollars in debt due to small copays that don’t exceed $30 a visit. There are not a lot of bills that are over $500 in the office, when you look at it as a whole. The only other most common debt is ER debt, where it’s about $328 in this case, and it’s because insurance wasn’t provided at the time of services and then all the bills were ignored that the hospital sent. Usually these people try to get insurance to handle it anyways once we’re contacting them (or it ended up on their credit), and sometimes they succeed, but most times it is rejected due to timely filing (and if they had submitted it to insurance when the hospital sent the first bill, it’d be no issue).

Going back to the copays though, do you know how many people cannot be bothered to pay them? So many! There are so many people that we call to let them know they have hundreds of dollars in copays that are long overdue, try to set up a payment plan, and they just flat out refuse. The reasons are usually bad ones, too. I’ve heard everything from “I don’t feel like it” to “Well I didn’t like the services, so even though they were provided I’m just not going to pay”. It’s crazy. People just honestly don’t want to pay for the services they received, and so they don’t. There’s only so much we can do as a collection agency, and with small debt like that (which most of it is), we don’t have many options. So they get away with it.

Think though. 75% of what we’re after is small debt. It likely adds up to well over $500,000 worth of debt, just the stuff that isn’t outside of statute. And that’s in one small little office. Think about how that probably is across the country, and you have a whole slew of people who are just hellbent on not paying their share. After all, that’s all a copay is, their share of the cost. And they don’t want to pay it. But you somehow think these same people will contribute on a single-payer system? Sure, if they’re taxed on it. But because of their mindset, they’re probably just as likely to be the kind of people to work the system in their favor so they don’t have to pay those taxes, either. Mind you, I’m talking about people who are already abusing the system, not people who actually have legitimate need. We don’t have issues with people who have legitimate need. Oddly enough, they seem to get it and work with us to set up payment plans when we unfortunately have to inform them that even Medicaid and similar have copays (some people we collect from just weren’t fully informed).

It’s not just copays either though, some of it is sheer laziness.

Consider This: Hospitals love to write things off to charity, it helps with their taxes. So most hospitals have Financial Aid Programs and Community Care, all you have to do is ask. If you tell a hospital you have a hardship, they will usually try to work with you. They’ll even do payment plans so your bills don’t end up in collections. This even applies to large bills after insurance.

As a bill collector, it has also been my honor to be able to help people navigate the tricky road that is medical debt. So many people are unaware of financial assistance programs that hospitals provide, and I have been able to help point people in the right direction. As a collector I am not heartless to your plight. But you have to understand, I have also heard all the tired sob-stories one uses to try and rig the system, so I also have to remain neutral. Still, if you tell me you are just overwhelmed by your debt, there are some resources I can point you to for the specific hospital we collect for. And I’m sure this is not something that’s unique to this one hospital. If you’re that person who’s experiencing hardship, even after insurance (because I have seen bills on occasion that were $50,000 and the copay after insurance is still $1,000 that people need help with), ask the hospital if they have a Financial Assistance Program (FAP for short). They probably do, and they’re usually happy to send you the paperwork.

I also have seen a severe lack of personal responsibility doing this. The second most common thing I have been told on the phone is “That’s worker’s comp”. Really? But the bill is over a year old, and funny, no one submitted to worker’s comp. Somehow these debtors tend to think that it is somehow mine or the hospital’s fault that it wasn’t submitted. Usually though what happened is: they did not submit a claim, and they did not make sure their employer did. They just assumed that it happened, and ignored everything. There’s no reasoning with them, either. Having gone through worker’s comp myself, I know how much follow-up it takes, and that sometimes you have to file for yourself because your employer won’t want to. Once again though, I’m typically met with resistance and people who in the end just don’t want to pay the bill. I’m sorry it wasn’t covered, but it’s your responsibility to make sure the claim is filed. Services were still rendered, and technically you’re responsible for the bill.

So essentially, my thought is this. We have this huge pool of people who have absolutely zero desire to pay their share, or their bills. Even when given alternatives that will help assist them in reducing the cost or giving them an easier way to pay (payment plans). They just don’t want to. I feel that there are enough of these people that will cause a single-payer system to fail, because they will drag down the morale of those who are paying for them. It’s this concept: You give, and give, and give; and you watch as others who don’t just keep receiving. So you start thinking, why should I give all this, when I see others who don’t and still reap the benefits? Others who could be giving, but are choosing not to do so? And so in the end, wouldn’t that tire you out and so you decide to be another person that just reaps the benefits? Probably. It’s tiring to watch people who are capable of helping do nothing, especially if you are doing something. Most people don’t have the willpower to push past that, I don’t think.

Single-payer would be nice, but please don’t think it’s a grand solution. It’s not. It has its flaws too. Those flaws need to be recognized when discussing it, because is it really so much better than our current system with its flaws; or are we just trading one set of flaws for an equally bad alternate set of flaws? From the perspective of bill collections, I think it’s the latter.

Remember also, every right we are guaranteed in the Constitution does not rely on anyone else giving us something. That’s why they’re fundamental rights. I will agree that everyone has the right to be healthy, in the idea that they should not be able to be turned down for pre-existing conditions and similar. However, I do not think that everyone has the right to receive healthcare from another for free. That’s because the receiving part requires action of another. Rights are something that have to be inherent to self to me. For example, I have the right to bear arms and own a firearm, but I do not have the right to make someone give a gun to me. I have the right to free speech, but I cannot force another to listen to me. So I will agree we all have the right to seek healthfulness, but we do not have the right to be treated for nothing.

In this way, I am all for an insurance reform that gives a wider range of options, perhaps has a sliding scale that can help those in need (much like income-based student loan repayment plans), and maybe even work to set up a charity who’s purpose is to assist with medical debt (if there isn’t one already). I like the marketplace that Obamacare set up, in that it allows you to easily compare plans. I think that is extremely important in driving down the prices of premiums. I think it’s important that insurance companies be held to certain standards as to what they cover, to make sure personal opinion is kept out of the loop (ie: not supplying birth control coverage because the company is owned by someone who is Catholic). I also feel that people who don’t want to buy insurance should not be punished with a fine (that is unconstitutional, as far as I can tell), because that is their choice.

So no, I don’t really believe in single-payer healthcare. However, I do believe if we actually dissect each issue we have individually with insurance companies, and how that works in the cost of medical care, that we just might be able to find a good middle-ground that actually has less flaws. And I learned this by trying to collect medical debt and taking a good look at what the actual problem children of society are.

Side Note: Final piece of advice to you. I mentioned above that many people don’t like to pay bills if they didn’t like the services received. Another thing most hospitals have is a customer feedback line. It might just be customer service. But if you had a really bad experience, there is a number you can likely call to let them know. I can’t guarantee compensation for it, but at least you can inform them.